Health Minister On Lamb Foggo Centre Closure

Good Morning Mr. Speaker,

I rise today to provide a statement on the decision of the Bermuda Hospitals Board to close the Lamb-Foggo Urgent Care Center in St. David’s.

Much has been said in the public domain, and criticism has been heaped on me personally from all quarters.

Mr. Speaker,
On my ‘failure to consult’, I appreciate the Leader of the Opposition giving me the opportunity to remind the public and my parliamentary colleagues that this government in general, and this Minister in particular, will not shy away from making or supporting difficult decisions that are pragmatic and morally right, and will not fall prey to those things which are simply politically expedient. It is this approach that has cut this country off at the knees, and it is one that I will not perpetuate.

I have tried not to be inhospitable to the Opposition for their role in placing the BHB in this dire situation, however, when misinformation continues to emanate from their quarters, it is important to put the facts to the Bermudian people.

The construction of the UCC was two-fold. One, to provide readily accessible URGENT health care to residents of the east end, and secondly, to ensure that the situation that obtained when Hurricane Fabian made the Causeway impassable would not disadvantage those east of the bridge who might need medical attention. It might be noted that another similar facility was planned for the West End, however, this never materialized.

Mr. Speaker,
I believe that a sensible and visionary approach for the East End would have been to use the funding to make the bridge safe, as our hospital is twenty minutes away. It should also be noted that the people of St. George’s would have been equally unable to access this facility if the swing bridge was out of commission.

The business model for the UCC was based upon the government’s infusion of some $800K per annum, just for the facility to break even. During the PLP administration, NO FUNDING was allocated for operational consideration. Further, the inability of the BHB to get audited financial statements since 2010/11 would not have allowed the former government to have a clue as to the operating deficit of the entire hospital, never mind the UCC, and the necessity to fund the new acute care wing, in conjunction with plant operations for the existing structure, along with the crumbling infrastructure at MWI, has put further strain on the BHB financing.

It is also worthy of note that of the key drivers of the original plan, advanced by David Hill, the then CEO, Neil Rolfes, the then Chief Business Development Officer, Dr. Donald Thomas,III, the then Chief of Staff in conjunction with Kuron, the consultants brought in by the BHB, NOT ONE remains to ruminate on their plan, or the disaster left in its wake.

It was very clear, however, that the business plan dictated that a minimum of 8,182 visits would be needed for this establishment to break even. The reality is that an average of 5,500 people used the facility, and the people of Bermuda were left to pick up the shortfall, not directly through the consolidated fund, but through the resulting higher insurance premiums and higher costs of health care.

The Hospitals Board clearly articulated the position in their press conference last week, and I reiterate some facts of this situation:

• The Lamb Foggo Urgent Care Center [UCC] was running at a loss. On average, only 14 people attended per day, which amounted to about 5,500 persons per year. This attendance included many people who bypassed KEMH in favour of shorter wait times at the UCC, hence this service was not in reality, an East End service, but rather, morphed into a service that was simply ‘not KEMH’This volume was not sufficient to cover the operating costs of the facility. The UCC has sustained significant losses since its inception:
  • For Fiscal Year 2009/10, the loss was –$103,725
  • For Fiscal 2010/11, it was –$350,000
  • For Fiscal 2011/12 it was –$309,494 [unaudited]
• In Fiscal Year 2012/13, once all of the allocations relating to that cost centre have been applied, such as medical insurance, personnel costs and coverage provided by Emergency Personnel covering staff leave, unaudited indications are that there will also be a loss.
• The daily out-of-hours service catered to people with urgent, not emergency, needs. People arrived at the UCC mostly with sprains, cuts, bumps, bruises or needing basic x-rays, and under the current availability of the service, you are only allowed to be sick between 4:00 p.m. and midnight.
• By ceasing the UCC service, people do not lose access to care. The options they have now still exist, including:
  • Travelling to the Emergency Department if needed, or
  • Visiting their own General Practitioner [GP]
• By ceasing the service, however, BHB is able to save about $250,000 a year. The service itself cost at least $2.5 million to run.
• The BHB has determined that this money can be better used to support other vital services that are needed nationally, such as Dialysis, Oncology, Diabetes and the Emergency Department. Government and all Bermudians want to see a safe, high-quality, patient-centered Hospital continue to provide acute-care services for all. The BHB is the only entity with the mandate to do so.

I am confident that when presented with the facts, Bermuda will choose financial prudence, quality and sustainability.

The Bermuda Hospitals Board (BHB) is currently reviewing its costs and activities with a view to improve efficiency, improve quality and to raise patient satisfaction. However, it is no secret that BHB is facing a shortfall of funds by the end of this fiscal year. This is combined with the requirement to meet the obligation to pay the first installment for the new acute care wing of the hospital in 2014.

Mr. Speaker,
We all know that times are difficult. And the BHB is no different in needing to tighten up in areas of expenses. The BHB is also currently working to improve controls and enhance its Corporate Governance. One of the important decisions the BHB Board needed to make was surrounding the UCC. We have been advised that there are many more difficult financial decisions ahead, some of which may be supported by this government, and some may not.

To suggest that the OBA government is using two of its members who sit on the board to somehow make the decisions is just patently false.

Mr. Speaker,
The public were justifiably concerned about the short time-frame between the announcement and the expected closure of the UCC. However, in fairness, the BHB has made statements about its financial health and the need to reshape its services over the past several months.

Clearly the residents of the East End of the island appreciated the Urgent Care Center. No one disputes that. However, if we look widely at what is appropriate for Bermuda’s healthcare system, and for all of Bermuda, it is also clear that managing costs is the priority.

• In 2012/13, the cost per patient visit at the UCC was $422. This was nearly double the cost of a primary care visit in Bermuda.
• In contrast, a visit to the Emergency Department for a minor illness or accident visit would be between $276 to $392, not including the diagnostic tests. In other words, the care provided at the UCC can be more efficiently provided elsewhere.

The evidence that healthcare costs should be addressed urgently is that Bermudians have long found it difficult to afford rising healthcare premiums. In part, this decision to close the UCC will have a positive impact with respect to premium increases and will affect all Bermudians.

Mr. Speaker,
Two other important questions still remain unanswered:

1. What will happen to the UCC building and facility that received substantial investments to be developed?

2. What will happen to residents in the East End in the event of an emergency situation, such as a natural disaster or incident at the airport?

First, both the BHB and the Ministry recognize that while BHB cannot run a viable service from the facility with the current business model, another provider may be able to operate from the site at lower cost. For example, primary care providers are not as expensive as Emergency Department personnel. For this reason I have been personally working with the BHB to review alternative uses of this facility.

In fact, while the Opposition was making political hay out of the dire situation that they created, I was discussing possibilities for this facility with individuals who I hope will be able to provide a service. Time will tell if the overtures yield success.

Second, the safety and access to healthcare of East End residents in the event of a hurricane or other disaster is of great concern to us all. We are especially concerned about the provision of care when the causeway goes down. Clearly there is no medical alternative on the East side of the causeway at those times. These are issues of national importance and should be addressed accordingly.

Government has a National Security Disaster Committee to look at these issues. The Committee is considering how we respond to disasters and will consider how this changes if the UCC facility is not available. These issues need to be discussed at the national level in partnership with all emergency and first response personnel and this work is already underway.

Mr. Speaker,
I am sure you will agree that it is painful to have to acknowledge that over $5million was spent in the construction of this facility, and a further $2.5M on outfitting this facility. If we can make lemonade out of these lemons with a concept that could work, with or without BHB involvement, this government, with the support of the Bermudian people, is willing to try.

In closing, Mr. Speaker, I want to assure the public that the Government will continue to evaluate any recommendation put forward by the BHB and its Executive team to ensure that the health needs of our entire community are well served on an equitable and sustainable basis.

Thank you, Mr. Speaker.

Read More About